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Learn this stuff! > The Tune-Up (high-value topics) > Flashcards

The Tune-Up (high-value topics) Flashcards

1
Q

The local inflammatory response to burns is composed of vasodilation, increased capillary permeability, edema, and influx of inflammatory cells. What is the role of Nitric Oxide?

A

Nitric oxide in burns is a potent VASODILATOR via:
1. direct effect on vascular smooth muscle
2. indirect via stimulating other cytokines like substance P

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2
Q

How is desmopressin involved in treatment of von Willebrand’s disease?

A

Desmopressin, or DDAVP, is a synthetic analogue of arginine vasopressin.
It stimulates the release of von Willebrand factor and factor VIII from endothelial cells
- useful in von Willebrand patients, especially Type 1 where all multimers are present, just reduced.
- give 30 min before surgery.
- No effect in normal patients
- It is also an antidiuretic (think Diabetes insipidus)

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3
Q

Describe the clotting cascade:

A

Intrinsic: Why pay 12 when you can pay 11.98 at the crossroad?
Extrinsic: 3 plus 7 is also ten.
Common: Common people be like 10, 5, 2 ,1.

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4
Q

What are the tests for the intrinsic /extrinsic clotting cascades?

A

Brad PITT is intrinsically likeable and he can ACT / You PeT a dog on the external parts
PTT, ACT intrinsic
PT extrinsic

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5
Q

What is the coagulation test for Vitamin K deficiency/rodenticide toxicity?

A

PT

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6
Q

What are the circumanal glands?

A

Hepatoid glands that regress in adult females (are testosterone influenced).
Circumanal gland tumor, also referred to as perianal tumor/adenoma or hepatoid gland tumor is a common perineal neoplasm. Usually benign.

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7
Q

What is the alar fold an extension of?

A

Ventral nasal conchae

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8
Q

What are the following equations/laws?
LaPlace’s
Poiseuille’s
Starling’s
Bernoulli’s

A

LaPlace: T=PR (cylinder) T=PR/2 (sphere)
- bandages, heart (pressures)
Poiseuille’s: Q= πPr^4 / 8ƞl
- Vessels, drains (flow)
Starling’s: Movement of fluid (Qiv-int)= K x {[(HPc parietal - HPc visceral) - HPif] - COPc -COPif]}
- Pleura/interstitial
Bernoulli’s: ΔP= 4 (V2^2 - V1^2) or ΔP= 4 V^2
- Vessels (pressure)

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9
Q

Which nerve innervates the superficial digital flexor muscle?

A

SDF = median nerve

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10
Q

What is the action of the supraspinatus muscle?

A

EXTEND shoulder, advance limb

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11
Q

What are the (4) muscles that laterally/externally rotate the hip?

A

internal & external obturator
quadratus femoris
gemelli
They rotate the femur so the stifle turns outward (lateral).

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12
Q

What is the corpus callosum?

A

The corpus callosum is the primary commissural region of the brain consisting of white matter tracts that connect the left and right cerebral hemispheres.

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13
Q

Describe high V/Q mismatch and Low V/Q mismatch:

A

The V stands for ventilation, which is the air the patient breathes in.
The Q stands for perfusion, which is blood flow.

Essentially, the V/Q ratio is the amount of air that reaches the lungs divided by the amount of blood flow in the capillaries in the lungs.

When lungs are functioning properly, a V/Q ratio is around 1. A number that’s higher or lower is called a V/Q mismatch.

High V/Q (vent > perfusion): PTE

Low V/Q (vent < perfusion): atelectasis, pneumonia, severe pulmonary edema

(IMPORTANT)

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14
Q

What is the blood supply and venous drainage to the thyroid?

What is unique about the thyroid blood supply of the cat?

A

Cranial and caudal thyroid arteries. Cranial from common carotid (first branch!) / caudal from brachiocephalic artery.

Cranial and caudal thyroid veins -> internal jugular vein

In most cats, the caudal thyroid artery is absent. IMPORTANT

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15
Q

What is the innervation to the thyroid?

A

thyroid n. from the cranial laryngeal n. off the vagus n.

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16
Q

What percentage of cats have ectopic parathyroid tissue?

Dogs?

A

30-50%

3-6%

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17
Q

Which antibiotics are bacteriocidal?

A

Bactericidal antibiotics: remember “BANG Q R.I.P.”
Beta-lactams
Aminoglicosides
Nitroimidazoles (metronidazole)
Glycopeptides (vancomycin)
Quinolones
Rifampicin
Polymyxins (colistin)

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18
Q

Which antibiotics are bacteriostatic?

A

Bacteriostatic antibiotics: remember “Ms. Colt”
Macrolides
Sulfonamides (become cidal with TMS)
Chloramphenicol
Oxazolidinones
Lincosamides (clindamycin)
Tetracyclines

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19
Q

Which antibiotic combo is the best for anaerobic gram + and aerobic gram negative?

A

Lincosamides (clindamycin, lincomycin) for the Gram + anaerobes
Fluoroquinolones are your primary gram negative aerobe coverage.

  • Could use metronidazole, beta-lactam, for the gram + anaerobe.
  • Could use aminoglycosides for the gram negative aerobe.
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20
Q

Which antibiotic is used for perioperative biliary surgery?

A

Cefoxitin

+ ampicillin for enterococci

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21
Q

Which antibiotic does not cross the blood-brain barrier well?

A

Cefazolin

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22
Q

Is the presence of renal disease a contraindication for aminoglycoside use?

A

No? Maybe?
They’re nephrotoxic but they do use them in people just lower the dose frequency?

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23
Q

Do skin sutures increase the risk of surgical site infections?

A

NO

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24
Q

What type of protein is antithrombin?
What is it’s MOA?

A

An alpha globulin
Inactivates circulating coagulation proteins (thrombin, Xa) that escape from site of damage. Inhibits neutrophil adherence and is anti-inflammatory.
HMW Heparin activates it x1000

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25
Q

What is the diameter of the distal feline ureter?

Is ureteral dimension affected by neutering?

A

0.4mm

No, it has no effect in adult cats.

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26
Q

How much compression do you get using a 4.5 DCP plate?

A

1.0 mm

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27
Q

What is the AMI of an 8mm interlocking nail?
Compare to a 3.5 DCP plate?

A

Calculation of the moment of inertia for a nail uses the radius to the fourth power, and for a plate it’s the thickness to the third power.

The area moment of inertia in the solid section of an 8 mm interlocking nail is:
6.8 times that of a 3.5mm DCP
3.5 times that of a 3.5 mm broad DCP

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28
Q

Describe the (4) biomechanical advantages of an interlocking nail:

A
  1. Placed near neutral axis so takes compression rather than bending in weightbearing
  2. Large AMI (radius^4 vs thickness^3 for plate) gives more resistance to bending
  3. Locking mechanism gives stability in torsion and compression
  4. Intramedullary location eliminates risk of failure via screw pull out
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29
Q

What is the function of an LCP?

A

A locking compression plate combines the benefits of locking and compression via combi holes.
“Can be used as conventional compression plate or pure internal fixator (bridging plate).”

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30
Q

Is the Babcock forceps a crushing forceps?

A

Yes

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31
Q

How do synthetic colloids cause coagulopathy?

A

Decrease von Willebrand factor and Factor 8
Interfere with fibrin clot stability
Impaired platelet function

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32
Q

Hypertonic solutions cause complications
when given at faster than what rate?

What are the complications?

A

> 1ml/kg/min
Osmotic stimulation of pulmonary C-fibers, which leads to vagally mediated hypotension, bradycardia, and bronchoconstriction.

Hemolysis/phlebitis if given in small veins due to the hypertonicity of the fluid.

Arrhythmias if given via jug cath to R atrium

**dehydrated patients are volume depleted and won’t benefit much/will get more dehydrated

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33
Q

What are complications of epidurals?

A

Horner’s syndrome
Phrenic nerve paralysis (respiration)
urine retention

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34
Q

Where do you perform an epidural?

Why is morphine good for epidurals?

A

L7-S1 space

It has relatively low lipophilicity so it hangs around up to 24hr

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35
Q

Where is the pancreas in relation to the omentum?

A

It is in the veil of the greater omentum according to all documents.

Book says the dorsal leaf of the greater omentum (you gotta lift/tear the ventral portion to get there).

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36
Q

What is the precursor to all prostaglandins?

A

PGH

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37
Q

What is misoprostol an analog of?

A

Prostaglandin E1
- prevents and helps heal GI ulceration
- Also inhibits IL-1, TNF, TxA, histamine release, enhances effect of NSAID

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38
Q

How does wound healing differ in dogs vs cats?

A

Generally speaking - cats heal weaker and you should leave their sutures in a little longer.
* Cats have lower cutaneous perfusion for the first week (by 2 weeks, no difference)
* Cats have a significantly lower wound breaking strength 1 week post-op
* Open wounds in cat heal largely by contraction whereas dogs heal largely by central “pull” of fibroblasts and epithelialization
*at 14 days 44% of canine wounds are reepithelialized compared to just 13% of cats

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39
Q

After wound healing, how much type 3 collagen remains?

A

10%

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40
Q

Where do wounds heal via contracture?
Via epithelialization?

A

Contracture - trunk
Epithelialization - limbs

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41
Q

What innervates the bladder in it’s active phase?
Resting phase?

Somatic control?

A

Resting: Hypogastric sympathetic (store) beta receptors relax detrusor

Active: Pelvic (pee) nerve parasympathetic to muscarinic receptors -> contract detrusor

Somatic: pudendal n.

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42
Q

How is defecation stimulated/coordinated (nerves)?

A

Intrinsic: enteric nervous plexus in the rectal wall senses distention -> involuntary rectal contraction and internal sphincter relaxation

Extrinsic: pelvic plexus
Parasympathetic (pelvic n.) ->rectal contraction and internal sphincter relaxation
Sympathetic (hypogastric n.) -> inhibit rectal contraction and excite/constrict anal sphincter.

Intrinsic system is weaker than the extrinsic -> allows conscious control. Sensory from pudendal lets brain know defecation is imminent, then extrinsic control kicks in to allow voluntary constriction/hold poop in.

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43
Q

Which causes diastolic dysfunction?
Pericardial effusion
Pulmonary hypertension
or
Mitral valve disease?

A

Pericardial effusion

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44
Q

How long can you store something in heat-sealed plastic wrap that was Ethylene oxide sterilized?

A

12 months

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45
Q

What are the physical sterilization indicators?
The chemical?
The biological?

A

Physical = graphs and printouts verifying temp/pressures achieved
Chemical = React to parameters with color changes - six classes you want a class 1 (sterilization tape) on outside and another class inside the pack
Biological = BEST indicators of efficacy do it weekly
Geobacillus stearothermophilus (steam, ozone, plasma)
Bacillus atrophaeus (Ethylene oxide)

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46
Q

What is the MOA of Chlorhexidine?
Is it good against MRSA?
Is it good against spores?
Is it ototoxic?
What makes it precipitate?

A

MOA: varies with concentrations
Lower concentrations: bacteriostatic effect by interfering with the cell membrane and causing leakage of cell contents
High concentrations: bactericidal effect caused by coagulation of cellular contents

Yes MRSA
NO spores
Yes ototoxic (don’t prep the ear with it)
Chlorhexidine gluconate precipitates over time in the presence of citrate or chloride ion.

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47
Q

How long can you ligate the abdominal aorta for?
The thoracic?

A

Temporary Ligation Times in Normothermic Animals:

Descending thoracic aorta → 5-10 minutes

Abdominal aorta → 30 minutes

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48
Q

Which hormone is synthesized the least in normal conditions in the adrenal glands?

A

Sex hormones (reticularis)

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49
Q

What color light does an argon laser produce?

A

Blue-green

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50
Q

What are the cardiovascular effects of positive pulmonary ventilation (PEEP)?

How should you set your ventilator?

A

Increased peak inspiratory pressure causes decreased venous return -> decreased stroke volume and therefore decreased cardiac output.

You should set an initial PIP of 12mmHg and set tidal volume at 10-15ml/kg then titrate to right level to maintain end tidal. I:E ratio should be 1:2

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51
Q

What is an enthesis?

A

The point at which a tendon inserts into bone, where the collagen fibers are integrated into bone tissue.

Those dense bands of collagen fibers that penetrate into cortical bone are Sharpey’s fibers.

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52
Q

Which local anesthetic is the least chondrotoxic?

A

Mepivacaine

In order Mepivacaine < Ropivacaine < bupivacaine

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53
Q

What are type 1 muscle fibers?
Type 2?

A

Type 1 fibers are rich in mitochondria, rely heavily on oxidative metabolism, and are slow-contracting and slow-fatiguing. They are SMALLER fibers with smaller nerves. Called red muscle from myoglobin.

Type 2 fibers have fewer mitochondria and are glycolytic, fast-contracting, and more easily fatigable. They have LARGER fibers for strength.

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54
Q

What is a swaged needle vs non-swaged?

A

With a swaged needle, the suture is placed inside the hollowed end of the needle and crimped in place by the manufacturer. This anchors the suture to the needle, and the suture must be cut to free the needle.

Swaged needles are less tissue traumatic than non-swaged (which have an eye for threading)

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55
Q

What is the difference between a standard cutting and a reverse cutting needle?

A

Reverse cutting needles are the same as a conventional cutting needle except the third cutting edge is on the outside or convex curvature.

These needles are stronger than conventional cutting needles and have a lower chance of pulling through because the flat edge is parallel to your incision - less risk of larger hole/path.

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56
Q

How many throws of suture should you do to START a continuous pattern with PDS?

A

5 throws

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57
Q

What initial tension should you tighten your cerclage to?
How many newtons of load can a cerclage resist (load to loosening)?

A

Twist: 70-100N Loosens at 260N
Single loop: 150-200N Loosens at 260N
Double loop: 300-500N Loosens at 666N

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58
Q

Secondary closure is an example of what type of healing?

A

Third intention - closure after granulation tissue forms!

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59
Q

What is the cause of carprofen’s liver toxicity? Is it dose dependent?

A

Idiosyncratic
NOT dose dependent

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60
Q

How do NSAIDs hurt the GI?

A

Local and systemic effects.
Local: NSAIDs diffuse across gastric mucosal epithelial cell membranes into the cytoplasm, where they cause direct cellular injury.
Systemic: Through prostaglandin suppression which affects natural defense of mucus, mucosal layer, blood flow.

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61
Q

How do NSAIDs hurt the kidney?

A

PGE2 (COX 1) and PGI2 (COX 2) are important for maintaining renal bloodflow and ion transport via medullary vasodilation even when the renal arteries are vasoconstricted
So If you take away this protection by giving NSAIDs - any insult or disease condition can be worse.

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62
Q

Why should you prep an ear with povidone iodine and NOT chlorhex?

A

Chlorhexidine is ototoxic

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63
Q

What PaO2 is necessary for neutrophil function in the wound bed?

A

> 40mmHg

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64
Q

Dobutamine is used to treat decreased stroke volume from myocardial depression.
What is the MOA of dobutamine?

A

Beta-adrenergic agonist (very little alpha)
Positive inotrope
Positive chronotrope
May cause seizures in CATS

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65
Q

Dopamine is used to treat decreased stroke volume from myocardial depression.
What is the MOA of Dopamine?

What is the other thing you can use it for?

A

Low dose = dopaminergic receptors cause vasodilation
Intermediate dose= Beta1 agonist, positive chronotrope and inotrope
High dose = Alpha agonist, causes vasoconstriction -> reverses vasodilation

**weird phrase on test: “Dopamine can be used as part of balanced anesthesia to reverse the vasodilation caused by anesthetic drugs.”

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66
Q

What vessel supplies the left limb of the pancreas?

A

The splenic artery (a branch of the celiac)

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67
Q

What artery supplies the cecum?

A

ileocolic artery

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68
Q

Delta cells in the pancreas secrete which hormone?

A

Somatostatin

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69
Q

Tracheal diameter ratio of width to height is what?

A

1:1 (it’s a circle)

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70
Q

What type of forces cause oblique fractures?

A

Compressive shear forces

Compressive loading + oblique shear = oblique Fx of osteons -> propagates along Haversian canal.

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71
Q

What does the Organ of Corti do?

A

Converts sound waves to nerve impulses in the ear

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72
Q

What is normal tidal volume in a dog?

A

10-20 mL/kg

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73
Q

When you have pleural fluid, it decreases the tidal volume. What must happen to maintain a stable minute volume?

A

Increased respiratory rate

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74
Q

Starvation depletes the body’s stores of what ions which then cause refeeding syndrome?

A

Intracellular cations, especially phosphorus (Mg, K too) they get moved to ECF to support function.

When food is reintroduced, they rush back into cells, causing mayhem as they decrease the plasma concentrations.

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75
Q

What setting should you use on your electrosurgery when passing current through a hemostat?

A

The “cut/cutting” setting (NOT coag)

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76
Q

Why do non-rebreathing circuits require a high flow rate of O2?

What is the calculation for fresh gas flow in a non-rebreathing circuit?

A

To clear out/prevent rebreathing of CO2

FGF= 3x Minute Volume (MV = TV (10-20mL/kg) x resp rate)

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77
Q

What does the one-way valve on a rebreathing anesthetic circuit do?

A

Keeps expired air away from patient (can’t flow back)

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78
Q

What is the function of the pressure regulator on your anesthesia machine?

A

Reduce pressure of incoming O2 to 45-50psi if coming from a higher pressure container/line (just like a SCUBA regulator)

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79
Q

What is the function of soda lime?
What is soda lime made of?

A

Absorb CO2 by converting to carbonic acid which decays into calcium carbonate making heat and water.

Soda lime is sodium hydroxide, potassium hydroxide, water, and calcium hydroxide
It has an indicator dye that reacts to acid (purple) when it is present. It is granular and 4-8 mesh in size.

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80
Q

What cranial nerves are involved in the oral phase of swallowing?

A

5,7,12
It is the only voluntary phase

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81
Q

How long do you need contact with alcohol-based hand scrub solutions?

A

2 minutes

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82
Q

What is made by the body that is required for a biofilm to develop?

A

A conditioning layer of secretions (protein, polysaccharides) around the implant.

Bacteria then adhere to the layer via adhesins that interact with the fibronectin on the film.

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83
Q

Where do you find hair follicles?

A

In both the dermis and hypodermis
(this is why if dermis is lost burned/scarred areas have no hair/normal glands)

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84
Q

What do Chief cells in the stomach make?

A

Pepsinogen -> pepsin ->protein breakdown

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85
Q

What do parietal (oxyntic) cells in the stomach make?

A

Gastric acid -> pump out hydrogen ions to keep pH 2-3 **only cell that makes HCL
Also make intrinsic factor for B12

Do not confuse with Oxyntic glands which contain all three (mucus neck/chief and parietal cells)

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86
Q

How long can you apply a tourniquet for?
Should you use an Esmarch to exsanguinate a limb if you suspect it has a neoplasm?

A

Apply for the shortest possible time, but 1.5-2hr max

NO - Not if you think it is infected either

*width is inversely related to pressure so use a wider one to prevent local injury from pressure. (LaPlace’s Law)

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87
Q

What (3) things do the endocrine cells of the stomach secrete?

Where are these cells found?

A

gastrin, histamine, serotonin

They are in the body of the stomach

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88
Q

Does the esophagus have a serosa?

A

NO
Adventitia

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89
Q

Unlike other systemic veins, the pulmonary and umbilical veins do what?

A

Carry oxygenated blood

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90
Q

The caudal laryngeal nerve provides motor to all intrinsic muscles of the larynx except WHAT?

A

Cricothyroideus

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91
Q

What is the MOA of propofol?

A

A GABA agonist, propofol increases CNS inhibition

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92
Q

Dogs form a full granulation bed at how many days?
How many days for cats?

A

7.5 days dog

19 days cat

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93
Q

How much of total body water is intracellular? How much is extracellular?

A

Intracellular is 2/3
Extracellular is 1/3

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94
Q

How much of total body calcium is found in bone?

A

99% (Test said 97% last year)

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95
Q

Why do burns heal so slowly?

A

Low cytokine levels (only 5% normal FGF-2)
Poor capillary perfusion

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96
Q

How do NSAIDs prevent central sensitization in OA?

A

COX inhibition - COX enzymes play a role in central sensitization

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97
Q

What is interesting about the gubernaculum /testis in the abdominal cavity?

A

It is intraabdominal BUT extraperitoneal

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98
Q

100% oxygen is the most common carrier gas - why does it cause more alveolar collapse than 40% O2?

A

The nitrogen in air is not absorbed, so it stays in the alveolus to keep it structurally open. If you’re on 100%, it can just collapse.

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99
Q

What are the 6 classes of chemical sterilization indicators?

What two do you usually want?

A

Class 1 = tape on outside
Class 2 = Bowie-Dick (air removal)
Class 3 = temp or time indicators
Class 4: multiparameter
Class 5: all types of parameters for that type of sterilization
Class 6: Unique indicators for specific diseases (Prions) or specific instruments

A class 1 on outside and class 5 inside

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100
Q

What % of normal strength does wounded skin have at 10-14 days after surgery?

How about at 3-4 weeks?

A

5-10%

At 3-4 weeks is 25%

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101
Q

When can you repeat harvest of bone graft from the humerus? From the tibia?

Which is preferred? Tibia or Humerus?

A

Humerus 8 week
Tibia 12 week

*Greater weights of bone were consistently harvested from the humerus than from the tibia. Restoration of cancellous bone was more rapid and complete in the humerus than in the tibia.

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102
Q

What are three cytokines that have osteopromotive function?

A

IGF-1
PDGF
TGF-B

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103
Q

What is the definition of a nosocomial infection?

A

An infection in a patient hospitalized for >48hr before onset of signs/symptoms of infection

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104
Q

What is the infection rate for clean-contaminated procedures?

A

5.9%
(previous years 3.5-5%)

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105
Q

How long does it take a platelet aggregate to form a soft clot?

A

30 seconds

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106
Q

What does the t-wave represent on an ECG?

A

Repolarization of the ventricles

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107
Q

The transmyelohyoid approach for intubation is like doing an E-tube version of an endotracheal intubation through the tissues of the ventral jaw. What is it for?

A

For dental occlusion checks in oral procedures.

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108
Q

MOA of Amantadine?

A

NMDA receptor antagonist (was an antiviral and then used for Parkinson’s due to dopa/NMDA effects).

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109
Q

Which of these local anesthetics last longest to shortest:
bupivacaine, lidocaine, prilocaine, mepivacaine

A

Bupivacaine (180-480min)
Prilocaine (120-180 min)
Mepivacaine (90-180 min)
Lidocaine (60-120)

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110
Q

What is the lipophilicity of bupivacaine vs lidocaine?
Is bupivacaine cardiotoxic?

A

Bupivacaine 30 (times that of procaine)
Lidocaine 3.6
Yes, CNS and cardiotoxic

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111
Q

Where is the ventilatory dead space?

A

Nares, nasal cavity, pharynx, larynx, trachea, bronchi, and bronchioles. (the conducting airways/anatomic dead-space)

Alveolar dead-space is caused by alveoli that are poorly perfused with blood, so that gas exchange cannot occur optimally.

Physiologic dead-space is the sum of the anatomic and the alveolar dead-space.

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112
Q

What are the Salter-Harris classifications?

A
  • Type I: Fracture through the physis; most common
  • Type II: Fracture across the physis and extends into a portion of the metaphysis
  • Type III: Fracture involving the physis and epiphysis (this type extends into the joint)
  • Type IV: Fracture involving the physis, epiphysis, and metaphysis (this type also extends into the joint)
  • Type V: Compression injury of the physis
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113
Q

What ASA would you assign a patient with pneumonia?
With heart failure?
With GDV?
With pneumothorax?
Renal failure?

A

CHF = ASA 4 if active / ASA3 if resolved
GDV = ASA 4
Pneumothorax = ASA 4
Pneumonia is probably a 4? (constant threats to life).
Renal failure = 3

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114
Q

Describe the epiphyseal plate and the zones of cartilage in the physis:
What is the epiphyseal line?

A

Resting (epiphyseal side)
Proliferative
Hypertrophic
Mineralization (diaphyseal side)

When the chondrocytes in the epiphyseal plate cease their proliferation and bone replaces the cartilage, longitudinal growth stops. All that remains of the epiphyseal plate is the epiphyseal line.

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115
Q

What are the zones around a burn?

A

Moving outward from point of greatest energy:
- Zone of coagulation: no viable tissue remains
- Zone of stasis: reduced perfusion due to damage to RBC membrane proteins and reduced luminal diameter of capillaries due to increased interstitial pressure (FROM EDEMA). **Tissues in this zone may be saved or may deteriorate (vulnerable)
- Zone of hyperemia - Primary zone of the inflammatory response

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116
Q

What is the functional reserve capacity of the lung in mL/kg?

A

45 mL/kg

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117
Q

What is the MOA of atracurium?
What are reversal agents?

A

Atracurium antagonizes acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate. (a non-depolarizing block).

Reverse with acetylcholinesterase inhibitors:
neostigmine, edrophonium, and pyridostigmine.

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118
Q

What are the two functions of the ridges/cutouts on an LC-DCP?

A

Reduce extraosseous blood supply compromise
reduce screw hold stress by evenly distributing it along the plate

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119
Q

What are the 4 things needed for bone healing?

A

four major elements, including:
(1) mechanical environment
(2) osteoconductive scaffolds
(3) osteogenic cells
(4) growth factors

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120
Q

Which direction should you place the bowls when doing steam sterilization?

A

DOWN - no bowls facing up as need all air to displace/go down.

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121
Q

How do masks affect bacterial load in the OR?

A

No evidence to suggest they help?

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122
Q

Which has more residual activity? chlorhexidine or iodine?

A

Chlorhexidine
Chlorhex + alcohol prep has best residual activity

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123
Q

How does atropine differ from glycopyrrolate?
Does atropine cause sedation?
How do they affect GI motility?
What is the dose of atropine?

A

Atropine has faster onset, shorter duration
Glyco slower onset, longer duration, 4x as potent
- Atropine causes sedation because it crosses the BBB
- Both cause decreased GI motility and reduce LES tone
Dose of atropine: 0.01mg/kg to 0.04mg/kg

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124
Q

How strong is wounded skin at 14 days after surgery?

A

Only 5-10% of normal

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125
Q

Which bacteriostatic antibiotic can be cidal at certain concentrations in some tissues?

A

Clindamycin

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126
Q

Is metronidazole bacterio-static or -cidal

A

Cidal

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127
Q

What is the first ECG sign as AV block is starting?

A

Prolonged PR intervals
Normal PR is 0.16 sec, >0.2sec is prolonged PR

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128
Q

What is responsible for the cushioning in cartilage/ makes it resilient to compressive loads?

A

Water and proteoglycans

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129
Q

Which is more important for the wound bed to heal? PaO2 or oxygen content of hemoglobin?

A

PaO2

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130
Q

High V/Q mismatch is caused by what?

A

PTE
Responds well to supplemental O2

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131
Q

How many days prior to surgery should you discontinue antithrombotics?

A

For platelet drugs you don’t have to stop them. But if you did, it would be 7-8 days (platelet lifespan is 6-8 days).
For others you do a bridging therapy with LMW Heparin (enoxaparin) starting 2-3 days before, last dose is 24hr before.

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132
Q

A left to right shunt in the heart leads to what?

A

Left atrial dilation and left sided failure

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133
Q

What muscle attaches to the accessory process of the thoracolumbar vertebrae?

A

Longissimus

Accessory processes extend caudolaterally from the pedicles and are the attachment site for the tendon of the longissimus lumborum musculature.

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134
Q

What passes through the lateral vertebral foramen?

A

The first spinal nerve and the associated vasculature.

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135
Q

Which type of screw has a greater thread pitch and depth, cancellous or cortical?

A

Cancellous

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136
Q

What is the MOA of iodophors?

A

MOA incompletely understood - we think the molecular iodine (I2) is substituted in stuff or oxidizes which denatures proteins.

Involves disordering protein structure, blocking protein synthesis, and altering the cell membrane.

They are inactivated in blood and organic debris and can be irritating to skin

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137
Q

How does a lung lobe torsion cause an increase in hydrostatic pressure?

A

Initial compression of the veins draining from the lung lobe causes engorgement and swelling of the lobe with blood -> increased hydrostatic pressure in the vessels -> pleural effusion begins to develop as hemorrhagic fluid leaks from the surface of the lung.

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138
Q

What is the difference in layers between veins and arteries?

A

Arteries have elastic fibers in the tunica media / veins have “valves”
BOTH have three layers - externa/media/intima

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139
Q

How many “sphincters” does the esophagus have?

A

two… but the cranial one is difficult to delineate (it is confluent with pharyngeal structures)

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140
Q

What is a concern with xenon/halogen light sources in the OR?

A

They can set your drape on fire or burn tissue

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141
Q

What is the most common light source in endoscopy/laparoscopy/arthroscopy/thoracoscopy?

A

Xenon - less yellow (more like natural light), very bright

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142
Q

Should you use diazepam in patients with liver disease?

A

NO

Use midaz if you have to, it’s metabloites are not active.

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143
Q

What is the lifespan of platelets?

A

6-8 days

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144
Q

What does the lateral meniscus attach to that makes it less prone to injury in CCLR?

A

Meniscofemoral ligament (moves with femur)

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145
Q

How does the atlas articulate with the occipital condyles?

A

The atlas does not have a “body”
It is two lateral masses joined by dorsal and ventral arches, constituting a bony ring for the beginning of the vertebral canal.
The lateral masses present two cranial articular fovea for articulation with the paired occipital condyles and two caudal articular fovea for articulation with articular surfaces of axis.

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146
Q

Monopolar cautery works best when it is not in what?

A

Saline or blood

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147
Q

Are Bulldog forceps crushing or non-crushing?

A

Non-crushing

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148
Q

What is in cryoprecipitate?

A

vWF, factor 8, fibrinogen, fibronectin

Commonly used in von Willebrands patients for procedures

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149
Q

How long can you store whole blood/PRBCs?

A

At 4C for up to 35 days

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150
Q

What is a drawback of chemical indicators of sterility?

A

In general they tell you that the conditions for sterilization were met, but not that everything is truly sterilized.

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151
Q

What are the two bacteria used as biological indicators?

A

Geobacillus stearothermophilus (steam, ozone, plasma)
Bacillus atrophaeus (Ethylene oxide)

152
Q

What are the four motions of the scalpel blade?

A

sliding, pressing, sawing, and scraping

  1. Slide cuts yield precise depth, length, and control of direction and are used most commonly for making skin incisions.
  2. Press cuts or stab incisions are useful for opening fluid-filled chambers or making initial entry into a body cavity. Pressure and motion occur in the same direction with a press cut, but depth is poorly controlled.
  3. Sawing (e.g., transecting a ligated pedicle) allows continuation of a cut without removal and reinsertion of the blade (newbies saw the skin)
  4. Scraping is a method of separating tissue layers.

Incisions with a scalpel have 2x the wound strength of electrosurgery at 10 days

153
Q

Does perioperative administration of oxygen help to decrease SSI rates?

A

Yes

154
Q

What are the classifications of SSIs (From CDC table)?

A

Superficial incisional (skin, SQ, 30 days)
Deep incisional (muscle, fascia, 30-90 days *procedure dependent)
Organ/Space (any area other than the incision that was encountered at surgery 30-90 days)

155
Q

What are the natural anticoagulants?

A

protein C (stops 5a and 8a)
antithrombin III (binds thrombin and X)
Tissue factor pathway inhibitor (binds Xa, VII, TF)

156
Q

How is TNF-a related to monoclonal antibody use?

A

Experimental TNF specific monoclonal antibodies have been used to treat Crohn’s diseases and rheumatoid arthritis.

**Inhibition of TNF alpha for rheumatoid arthritis has been associated with recrudescence of pulmonary mycobacterial infection.

157
Q

How does hypoproteinemia affect anesthetic drugs?

A

Hypoproteinemia can lead to a more pronounced effect of most anesthetic drugs that are highly protein-bound. With less available plasma proteins to bind the drug molecules, there will be more active form of the drug.

Hypoalbuminemia results in reduced colloid oncotic pressure. -> tissue edema.

If the plasma oncotic pressure is significantly reduced, normal arterial blood pressure may be hard to maintain during anesthesia.

158
Q

What is a Ruskin rongeur?

A

Double action type (Mr. Chompy)

159
Q

What are the proinflammatory cytokines?
What are the anti-inflammatory cytokines?

A

Pro: TNF-a, IL-1B, IL-6, IL8 (TAB cola, 1968)

Anti: IL-1Ra, IL-10 (Rah-ten (rotten))

6 may do both…. (the 60’s were swinging)

160
Q

What is the precursor of all prostaglandins and thromboxanes?

A

PGH2

161
Q

What % of isotonic crystalloids are redistributed out of the vasculature in 20-30 min (or up to 1hr) after administration?

A

Should be 75% (but test may say 80%?)

162
Q

Describe 1st, 2nd and 3rd degree AV block on ECG?

A

First degree: All normal P waves are followed by QRS complexes, but the PR interval is longer than normal (>0.2sec).

Second degree: (PR is 0.25-0.45sec)
Mobitz type I - the PR interval progressively lengthens with each beat until the atrial impulse is not conducted and the QRS complex is dropped (Wenckebach phenomenon); AV nodal conduction resumes with the next beat, and the sequence is repeated

Mobitz type II - the PR interval remains constant. Beats are intermittently nonconducted and QRS complexes dropped, usually in a repeating cycle of every 3rd (3:1 block) or 4th (4:1 block) P wave

Third degree:
P does not conduct to QRS
Escape rhythms

163
Q

How does cardiac tamponade affect end diastolic pressure?

A

The hallmark of cardiac tamponade is elevation and equalization of diastolic pressures in all cardiac chambers.
Elevated left end diastolic pressure = increased preload, decreased stroke volume, decreased perfusion of coronary vessels.

*KNOW that contractility is not affected, but coronary perfusion is. Poor myocardial perfusion -> hypoxia

164
Q

What is the MOA of clopidogrel?

A

Irreversible antagonist of the platelet P2Y12ADP receptor
Pro-drug so it requires hepatic biotransformation to the active compound

165
Q

Describe the laryngeal anatomy:

A

6 cartilages: Epiglottic, Thyroid, Cricoid, Sesamoid, Interarytenoid, Arytenoid

6 intrinsic muscles: CAD, CAL, Thyroarytenoideus, Arytenoideus transversus, Hyoepiglotticus, Cricothyroideus

2 extrinsic muscles: Cricopharyngeus and thyropharyngeus

Drains to deep cervical LN

166
Q

How do D-Dimers and TEG fit into the coagulation stuff?

A

TEG measures the whole clotting response, it is best for hypercoagulability and if normal is a good indicator of a technical cause of bleeding.

D-dimers are degredation products that indicate active coagulation and fibrinolysis. Sensitive for thrombotic conditions but not specific (are good negative predictive indicator - if normal, unlikely to be throwing clots/in DIC).

If you don’t have TEG for hypercoag - can use D-dimers, just less specific

167
Q

What are the (8) types of sterilization?

A
  1. Flash sterilization
  2. Steam sterilization -> Kills via coagulation and denaturation of proteins by moist heat
  3. Plasma sterilization Uses electromagnetic energy to create plasma from H2O2 -> Plasma creates free radicals that deactivate cellular processes**
  4. Vaporized hydrogen peroxide
  5. Dry heat
  6. Ethylene Oxide -> Alkylation of proteins and nucleic acids lower temp
  7. Ozone sterilization -> Loose oxygen molecule that readily oxidizes other molecules to cause destruction of microorganisms
  8. Radiation (cobalt 60 gamma rays)
168
Q

How does skin contracture occur in dogs vs in cats?

A

Cat seem to heal more by contraction along wound edges

Dogs healed by central “pull” of fibroblasts and epithelization

169
Q

Describe the anatomy of the mandibular salivary gland:

A

Mandibular is at caudomedial angle of mandible medial to the bifurcation of the linguofacial and maxillary veins.
The cranial border of the mandibular abuts the sublingual and they share a capsule.
Their shared duct opens at the sublingual caruncle lateral to the lingual frenulum.
Supplied by the glandular branch of facial artery.
Drains to medial retropharyngeal LN

170
Q

What does hypoventilation look like on capnography?
What about hyperventilation?

A

Hypoventilation = progressive elevation of the plateau above the line
Hyperventilation = progressive decrease in height of plateau
Rebreathing CO2 = baseline is elevated
Leak in system = peak reached but trails off downward (no plateau)

171
Q

Catecholamines (epi/norepi) are released by the normal adrenal glands. What are the % for each?

A

Broadly, it’s 80% Epi and 20% Norepi

Technically, it’s species specific:
Dogs: 60%(epi), 40% (norepi)
Cats: 70% (epi), 30% (norepi)

172
Q

Describe prevalence and incidence?

A

Prevalence: The number of cases of disease in a known population at a designated time.

Incidence: The number of new cases of disease that occur in a known population over a designated period of time.

173
Q

What is the innervation to the urethral sphincter?

A

For contraction:
Internal sphincter -> hypogastric n., alpha
External sphincter -> pudendal nerve (nicotinic) + pontine micturition center

174
Q

What is the effect of acidic pH on antibiotics?
Basic pH?
Hypertonicity/Hyperosmolarity?
Low oxygen environment?

A

Acidic: Penicillins inactivated below pH 6.0
Basic: Fluoroquinolones, aminoglycosides more effective in alkaline pH
Hypertonic/hyperosmolar: Impaired efficacy of beta-lactams
Low oxygen environment: Aminoglycosides inactive. Cidal drugs impaired due to slow reproduction.

**Pus is acidic and hypertonic/hyperosmolar
Cephalexin is good in abscesses

175
Q

MOA of Alfaxalone?

A

Steroid anesthetic
Enhances GABA- and glycine- mediated CNS depression
Can cause cardiac depression and apnea (less than propofol)
DON’T USE in DCM

176
Q

Describe the parathyroid anatomy/function/blood supply?

A

Chief cells make PTH.
Externals are at the cranial dorsolateral margin of the thyroid.
Internals are at the caudal pole of the thyroid.
The externals get blood supply from cranial thyroid. The internals get theirs from thyroid parenchyma. Drainage is thyroid veins.

177
Q

Describe the embryologic formation of the cervix?

A

Complete fusion of the paramesonephric (Mullerian) ducts produces a single cervix in dogs. This also produces the cranial vagina that merges to the urogenital sinus (vestibule).

178
Q

What are the aminoglycoside antibiotics? MOA?

A

Amikacin, Gentamicin, Streptomycin
Target bacterial ribosomes
Bind to the 30s ribosomal subunit
Binding is non-reversible -> cidal activity, concentration dependent
Oxygen dependent for cell entry -> not good for anaerobes
- but if combine with something that targets cell wall can do better

179
Q

Tarsal ligament anatomy - which are taut in flexion/extension?

A

Medial collaterals:
Long part - Taut in extension
Tibiocentral (short) - Taut in extension
Tibiotalar (short) - Taut in FLEXION *Most substantial component of MCL

Lateral collaterals:
Long lateral ligament - Taut in extension
Calcaneofibular short ligament - Taut in extension *Most substantial compontent of LCL
Talofibular (short) - Taut in FLEXION

(The two talar ones (tibiotalar and talofibular) are taut in flexion)

180
Q

What is the maximum longitudinal angle you can place your screws at in an LC-DCP plate?

A

40 degrees
(a regular DCP is only up to 25 degrees, both are 7 degrees transverse))

AO also says the symmetrical holes allow you to angle that 40 deg in either direction and apply compression at any level on the plate.

181
Q

What percentage of bacteria are left in hair follicles after scrubbing?

A

20%

182
Q

How much movement is there in the tarsocrural joint?

A

90%

183
Q

MOA of the dissociative anesthetics? (Ketamine mostly)

A

Antagonism of NMDA
Dissociation = higher brain function separated from unconscious function. Any systems not under conscious control (laryngeal function, respiration) remain normal.
Increases muscle rigidity and pressures (IOP, ICP)
Increases myocardial workload
**(do not use in heart patients or renal dz)

184
Q

Which vessels can you NOT ligate in cats?

A

You can’t do both jugular veins or both carotids

185
Q

What are the components of CSF?

A

Ultrafiltrate of blood with very few cells, little protein, and slightly less glucose than blood.

  • Produced by choroid plexus in ventricles, flows rostral to caudal:
    Lat. ventricles-> intraventricular foramina ->3rd ventricles -> mesenceph. aqueduct -> 4th ventricle -> etc.
  • Is in the subarachnoid space between arachnoid and pia
186
Q

What is the MOA of Tramadol?

A

Analog of codeine
In people it is metabolized to a full Mu, causes analgesia with serotonin and adrenergic receptor effects.
Dogs don’t metabolize that way - so weak Mu at best
Cats do make it, but it’s bitter so they hate it
Don’t mix with SSRIs or trazodone (serotonin syndrome)

187
Q

Which antibiotics can cross the blood/brain barrier?

A

TMS, Doxycycline, Rifampin, Metronidazole, Chloramphenicol (lipid soluble!)

Fluoroquinolones (sometimes)
3rd gen cephalosporin (if inflammation)

Timid DOgs Rarely MElt CHeese (For 3 Cents)

You should know that cefazolin does not cross**

188
Q

How many twists do you need on your cerclage?

A

1.5

189
Q

What do each of the islet cells in the pancreas produce?
Alpha
Beta
Delta
PP / F?

A

Alpha cells - glucagon
Beta cells - Insulin
Delta cells - somatostatin
F or PP cells - Produce pancreatic polypeptide

190
Q

Name some crushing and non-crushing forceps:

A

Crushing:
Babcock, Allis, Ochsner-Kocher

Non-Crushing: Doyen intestinal, DeBakey, Satinsky, Cooley, peripheral vascular clamps (Bulldog, patent ductus clamps)

191
Q

What is the blade length in relation to total length of Metzenbaum scissors?
Of Mayo scissors?

A

Metzenbaum: 1/4 overall length
Mayos: 1/3 overall length

192
Q

Which tenotomy scissors are ring handled?
Which are spring handled?
(Ophthalmic procedures)

A

Ring: Stevens
Spring: Wescott

193
Q

What is the difference in beveling between bone-cutting forceps and osteotomes?

A

Bone-cutters are paired, chisel-like tips and beveled on one side

Osteotomes are beveled on both sides

194
Q

How do you calculate volume of dehydration deficit? What are the units?

A

Body weight in kg x percent dehydration = deficit in LITERS

Fluid needs = Deficit correction
+ estimated ongoing losses
+ maintenance needs

195
Q

Should you avoid contact of screws with IM pin because of fretting?

A

YES
When a screw head is moving in relation to the plate hole,
or in relation to a nail, the passive layer is repeatedly destroyed and there is “fretting” and local corrosion in the area of contact.

196
Q

Buttress plating is a term used for plates that are applied to shore up trans-cortical defects within metaphyseal regions. How do you apply a buttress plate?

A

The term buttress plating is reserved for a plate that negates compression and shear forces within the metaphyseal region.

The plate is anchored to the main stable fragment and contoured to the smaller metaphyseal fragment to minimize displacement of the smaller fragment. Interfragmentary screw fixation is commonly used in conjunction with buttress plate fixation.

197
Q

Tarsal anatomy: What is the largest bone? Which tarsal bones is it in contact with?

A

Calcaneus
- Central (talocalcaneocentral jt)
- 4th (calcaneoquartal jt)
- Talus (talocalcaneal jt)

198
Q

What is the innervation and vascular supply to the tarsus?

A

Cranial tibial artery (becomes dorsal pedal and dorsal MT arteries)
Plantar branch of saphenous artery (medial and plantar)
Tibial nerve (becomes medial and lateral plantar nerves)
Common peroneal nerve
Saphenous nerve (sensation to dorsomedial tarsus and MT)

199
Q

How is gastrinoma caused by the pancreas?

A

Gastrin is normally made in the gastric endocrine cells. In gastrinoma, pancreatic islet cells (delta) that normally make somatostatin transform to secrete gastrin. -> hypersecretion of gastric acid and ulcers (Zollinger-Ellinger syndrome is a non beta-cell tumor of the panc)

200
Q

Are beta lactams time dependent antibiotics?

A

YES
and bactericidal
Interfere with cell-wall synthesis
Renally excreted

201
Q

What is the effect of anaphylactic shock on central venous pressure?

A

Decreased CVP

202
Q

When doing a plate-rod combo, can you make your plate shorter than if you were just doing a plate?
What % medullary fill should you aim for with your pin?

A

NO

35-40% medullary cavity

203
Q

What is the function of surfactant? Which cells produce it?

A

Alveolar type 2 cells. Surfactant increases lung compliance by lowering surface tension and reduces the amount of work needed to inflate the lungs.

204
Q

Can Ketamine be used in a cat with lower airway disease?

A

Yes, Ketamine maintains respiratory centers sensitivity to PaCO2 and causes some bronchodilation.

205
Q

Describe the drainage of blood from spleen to portal vein?

A

Splenic vein
-> Gastrosplenic vein
-> Portal vein

206
Q

What % of blood is stored in the spleen?

A

RBC → 10-20% (Test may just say 20%)
Platelets → 30 %

207
Q

What is the MOA of honey? What does the inhibin number of honey mean?

A
  1. Hyperosmolality
    - Dehydrate microorganisms and have a cidal and inhibitory effect on their growth
    - Draws exudate and accompanying debris out of the wound
    - Reduce surrounding tissue edema
  2. Enhanced antimicrobial effects
    - Presence of PHYTOCHEMICALS* and acidic pH of 3.2-4.5
    - Glucose oxidase acts on glucose in honey - produces *HYDROGEN PEROXIDE (0.003%)

Inhibin number = amount of dilution to which honey will retain its antibacterial activity (higher number = can be diluted more/ is more potent)

208
Q

What causes bleeding in Greyhounds?

A

Hyperfibrinolysis syndrome / fibrinolytic syndrome. Use Epsilon-ACA or Tranexamic acid (antifibrinolytic agents) which block the breakdown of clots.

209
Q

What percentage of parasympathetic function to the body is from the vagus?

A

80%

210
Q

What arthroscope do you use for the tarsus?

A

1.9mm 30 degree

211
Q

Where should you put the biological indicators?

A

No specific location for biologics - but it would follow that they should go in the deepest part of a pack.
Bios are only run weekly due to cost.

212
Q

What does acetaminophen cause in cats?

A

methemoglobinemia +/- hepatotoxicity and renotoxicity.
Cats are deficient in glucuronidation and sulfation abilities -> make NAPQI instead = badness.

213
Q

Should plasma sterilization be used with linens?
Does it require aeration?

A

No for linens
No for aeration

214
Q

What is Cheyne-Stokes respiration?

A

Respirations become faster and larger, then slower, followed by an apneic pause; caused by increased intracranial pressure.

215
Q

What is the effect of estrogen supplementation (DES) on USMI?

A

May improve smooth muscle contractility and sensitize to alpha-adrenergic stimulators (such as proin)

216
Q

What are good antibiotics for gallbladder surgery / best choice for septic bile peritonitis?

A

A second gen cephalosporin like cefoxitin plus ampicillin for enterococcus coverage.

**Yes, this is in multiple spots

217
Q

Tell me about cyanoacrylate (tissue glue). What are it’s byproducts? How about non-medical grade?

A

Supplied as a liquid monomer. Polymerizes when it contacts anions in moisture.
Should be applied over, and not in wound (will act as FB)
Breaks down into cyanoacetate and FORMALDEHYDE.
Non-medical glues have more short-chains that make more formaldehyde and have less breaking strength. Don’t use them.

218
Q

What is the ELISA for von Willebrand’s disease?

A

Check for presence of multimers: <50% of normal is deficient
Used as definitive confirmation after a BMBT is suggestive.

219
Q

MOA of Gabapentin?

A

The mechanism of action is not well understood.
-Thought to block voltage-gated Ca+ channels & decreases extracellular glutamate

While it is structurally related to GABA, it does not appear to alter GABA binding, reuptake, or degradation.

220
Q

What are the colors of the anesthetic gasses?
What is the tank capacity?
What is the PISS?

A

oxygen —green or white (Pressure is 2,200 PSI , E cylinder is 660L / H tank is 6,900L)
nitrous oxide—blue (Pressure is 745 PSI, E cylinder is 1,590L)
air—yellow (pressure 2,200 PSI, E cylinder 6,550L)
CO2 - Grey (pressure 838 PSI, E cylinder is 1,590L)
nitrogen—black )Pressure 2,200 PSI, H tank 6,400L)
helium – brown

Pin-indexed safety system (PISS) is for cylinder attachment, diameter-indexed safety system (DISS) is for central pipeline attachment.

221
Q

Tell me about thromboembolism with Cushing’s disease:

A

After surgery, risk of PTE is up to 72hr.

Cushing’s causes a hypermetabolic state with hypertension and increased PCV -> pro-clotting environment.

  • One study found dogs had increased procoagulant factors and circulating fibrinogen
  • Antithrombin was also deceased and increased thrombin-antithrombin complexes were noted.
222
Q

What is the innervation to the external anal sphincter?

A

Caudal rectal nerve - a branch of the pudendal n.

223
Q

Is infection in surgery usually endogenous or exogenous?

A

Most SSIs are caused by endogenous microorganisms that appear on the patient’s skin when the surgical incision is made.

224
Q

What is the mechanism of malignant hyperthermia?

Which two drugs are known to cause it?

A

Inherited defect in cellular ryanodine receptor (RYR1) -> Excessive and dysregulated intracellular Ca release -> muscle spasm, rigidity, hypermetabolic state

First sign: Abrupt increase in ETCO2 (or PaCO2) -> elevated temperature and HR
Caused by: Succinylcholine, halothane
Treated with: Dantrolene (stop inhalant /use TIVA)

225
Q

75% of central tarsal bone fractures are Type IV or V (comminuted).
Describe a type 4 central tarsal bone fracture:

A

Type IV with a medial fracture/slab and a dorsal slab is the most common type of fracture.
You need to rigidly fix both fragments - do the medial first to prevent joint collapse. The dorsal is articular.

226
Q

Describe the anatomy of the aortic arches (embryology):

A

1,2,5 degenerate
3 becomes common carotid artery
4 becomes heart/aorta
- usually left 4, if right 4 persists is PRAA
6 becomes shunts between the pulmonary and systemic arteries
- Left 6 becomes ductus arteriosus (PDA)
- Right 6 degenerates

227
Q

What is the blood supply to the transverse colon?

A

Transverse: Right colic and middle colic arteries

Cranial mesenteric -> common colic trunk:

Cecum: ileocolic artery
Ascending: ileocolic proximally, right colic distally
Transverse: Right colic and middle colic
Descending:
- Proximal: middle colic
- Distal: left colic off the caudal mesenteric
**Most distal part is - cranial rectal artery - also off cd. mesenteric

228
Q

What cells produce TNF-a?

A

Activated M1 macrophages are a major source of TNF-alpha.*

Also made by : Monocytes, macrophages, neutrophils, NK cells, and several others (T, B, fibroblasts).

229
Q

What cells form granulation tissue/the granulation bed?

A

Granulation bed is composed of:
capillary bed
fibroblasts
macrophages
a ground substance of collagen, fibronectin, and hyaluronic acid

230
Q

What is the major type of collagen in each musculoskeletal tissue and what % is it in each?
Bone/skin/tendon/ligament/cartilage?

A

Type I: present in bone, skin, ligaments, and tendons
- 90% of organic matrix of bone
- 80% of the dry weight of tendons
- 75% of ligaments is collagen (with 85% of collagen as type I)
- 80% of skin collagen is type 1

Type II: present in cartilage
- 50% of cartilage is collagen (with 85-90% of the collagen as type II)

Type III: present in skin(20%), around vessels, and newly formed wounds (90%)

231
Q

What is the dose of atropine?

A

In dogs, opioid-induced bradycardia is responsive to atropine, an anticholinergic agent. For treating of excessive vagal tone, the recommended dose is 0.01mg/kg to 0.04mg/kg IV or IM.

It can decrease GI motility and cause sedation (BBB)
It doesn’t work on alpha-2 reflex bradycardia

232
Q

How long does it take to sterilize with ethylene oxide?

A

29-65C (84-149F) for 120-300 minutes (2-5 hours)
After this it needs to be aerated - allows desorption of the toxic ETO residual contained in exposed absorbent materials (plastics/rubber).

233
Q

What is the strength of Monocryl? How does it compare to Vicryl?

A

Monocryl (poliglecaprone 25): Approximately 50% of its original tensile strength in 1 week and 20-30% at 2 weeks BUT has higher initial breaking strength.

Vicryl (polyglactin 910): Approximately 50% of its original tensile strength at 2-3 weeks

234
Q

What are the MACs of iso- sevo- and Nitrous Oxide?

A

Iso: 1.3% dog / 1.7% cat
Sevo: 2.1% dog / 3.1% cat
NO: 188% dog / 255% cat

235
Q

MOA of fluoroquinolones?

A

Topoisomerase inhibitor that prevents gyrase from cutting double stranded DNA -> DNA replication can’t continue.
Bacteriocidal

236
Q

Tell me about the lipid solubility of morphine?

A

The relative lipid solubility of morphine is set at 1 (it is the index) and it has LOW solubility.

High lipid solubility facilitates opioid transport into the biophase or site of action. -> High lipid solubility confers a more rapid onset of action.

Fentanyl is 580x as lipid soluble as morphine (much more rapid)

237
Q

How do you do the brachial plexus nerve block?

A

Brachial plexus block (C6, C7, C8, T1)
Puncture point is cranial to acromion and medial to subscapularis
Use nerve stimulator to locate needle placement
Once there is flexion of the elbow (musculocutaneous nerve)
If there is just extension of the elbow, needle has gone too caudal and stimulating just the radial nerve.
Bupivacaine 4mg/kg

238
Q

MOA of vasopressin?

A

Vasopressin (also called antidiuretic hormone or ADH)
Vasopressor on non-adrenergic V1 receptors (0.5-5mU/kg/min)
Synthesized in the hypothalamus.

In normal conditions, it acts in the collecting duct of the kidney to retain water -> increasing urine osmolality and decreasing urine flow.

During hypovolemia, vasopressin not only increases water retention, but exerts a powerful vasoconstrictor effect especially on smaller vessels.

239
Q

How do you measure cardiac output and stroke volume?

A

Cardiac output= HR x SV
CO= (MAP-CVP)/total peripheral resistance (another factor for CO)
SV = end-diastolic volume - end-systolic volume

240
Q

What is the size of the screw head, pitch, and core diameter for a 3.5mm DCP?

A

Dia. of thread 3.5mm
Thread pitch 1.25mm
Dia. of core 2.4mm
Dia. of head 6.0mm

241
Q

What is the antibiotic cause of MRSA?

A

Cephalosporins

Three MOAs:
- beta-lactamase inhibitors
- mecA gene encodes a mutation that causes reduced affinity for beta-lactam ring 🡪 resistance
- change in porin size

242
Q

What are Halstead’s principles (7)?

A

“A Gentleman Halstead, Always Observes The Principles”

Aseptic technique
Gentle tissue handling
Hemostasis
Apposition
Obliteration of dead space
Tension minimizing
Preserve blood supply

243
Q

How big should your IM pin be (% of cavity)?

A

IM pin should be 70% of medullary cavity (diameter)
IM pin with plate should be 35-40% medullary cavity (diameter)

244
Q

What bacteria are associated with septic arthritis in dogs? In cats?

A

Dogs:
Staph intermedius, Staph aureus, and beta-hemolytic Strep most common.
Staph canis is most common from congenital or neonatal exposure

Cats:
Pasteurella multocida and Bacteroides spp.
Reflects oral flora of the feline mouth and the frequency of penetrating cat bites.

245
Q

What produces glycosaminoglycan?

A

Biosynthesis of proteoglycans and glycosaminoglycans (GAGs) involves transcription and translation of the core protein gene, addition and sulfonation of glycosaminoglycan side-chains within the ENDOPLASMIC RETICULUM, and packaging within the GOLGI apparatus in preparation for secretion.

Chondroitin sulfate is the most prevalent GAG
Hyaluronic acid is an unsulfated “backbone” for making other GAGs

246
Q

Where do the cranial nerves exit the skull/brainstem?

A

I- cribriform plate
II- optic canal
III, IV, VI- orbital fissure/canal
V- ophthalmic (orbital fissure), maxillary (round foramen-> alar canal-> rostral alar foramen), mandibular (oval foramen)
VII- stylomastoid foramen / internal auditory meatus(?)
IX, X, XI- jugular foramen and, then, through the tympano-occipital fissure
XII-hypoglossal canal

247
Q

Describe the path of B12 (cobalamin) from digestion to absorption:

A

Vitamin B12 is released from dietary proteins in the stomach by acid gastric secretions

It is then bound to R protein and passes into the small intestine, in which pancreatic proteases (trypsin) digest the R Protein, thereby releasing Vitamin B12.

The free Vitamin B12 than binds to intrinsic factor (a mucoprotein), which is produced by the gastric mucosa in humans but appears to be produced primarily in the pancreas in dogs and cats.

The Vitamin B12-intrinsic factor complex is absorbed by the distal small intestines, especially the ileum.

248
Q

What is the most common tumor of the uterus?

A

Leiomyomas represent 90% in dogs
Cats get endometrial adenocarcinomas that like to met

249
Q

What is the effect of prostaglandin (PGE) on the kidneys?

A

Prostaglandins are synthesized by both the COX-1 and COX-2 enzymes in the healthy kidney and influence renal blood flow, glomerular filtration rate, renin release, and Na excretion

PGE2 and prostacyclin (PGI2) increase renal blood flow and glomerular filtration rate in normal conditions, resulting in greater tubular flow and secretion of potassium.

Under conditions of decreased renal perfusion, the production of renal PGs serves as an important compensatory mechanism.
PGI2 (and possibly PGE2) increases potassium secretion mainly by stimulating secretion of renin -> increased secretion of aldosterone.

PGE2 acts as a counterregulatory factor under conditions of increased sodium reabsorption. PGE2 decreases sodium reabsorption at the thick ascending limb of the loop of Henle.

250
Q

Doxapram dose and MOA?

A

CNS stimulant which causes an increased respiratory rate and tidal volume. Used in laryngoscopy if respiration is weak/anesthesia too deep and need to verify normal function/lack thereof.

Dose: 1.1mg/kg

251
Q

How does base deficit affect GDV necrosis?

A

Lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis.

252
Q

What is the role of lactate in GDV?

A

Most common acid/base abnormality in GDV patients is metabolic acidosis (base deficit) and lactic acid is a major contributor.

Lactate concentrations in dogs with gastric necrosis ( >6.6mmol/L) were significantly higher than that of dogs without gastric necrosis (<3.3 mmol/L)

Specificity and sensitivity of using plasma lactate concentration (cutoff of 6 mmol/L) to predict which dogs had gastric necrosis were 88 and 61%, respectively.

253
Q

What is a Tuohy needle?

A

A Tuohy needle is a hollow hypodermic needle for inserting epidural catheters.
The needle features an anti-coring curve at its tip designed to cause a catheter passing through the needle’s lumen to exit laterally at a 45 degree angle.

254
Q

How does operative time affect infection rate?

What % increase in infection rates for each additional person in OR?

A

For every additional hour of operating time 2x infection

30% per person

255
Q

What size vessels can a LigaSure seal? LDS (ligate-divide-staple device)?

A

LigaSure Can seal up to 7mm diameter vessels
LDS can occlude vessels > 2/3 the width or <1/3 width the staple size **should be several mm from cut edge

LDS comes in two sizes: 5.8mm and 8mm

256
Q

What are the 4 major classifications of shock?

A
  1. Hypovolemic- reduction in circulating intravascular volume
  2. Distributive- impairment of the mechanisms regulating vascular tone with maldistribution of the vascular volume and massive systemic vasodilation (sepsis)
  3. Cardiogenic- myocardial dysfunction, severe arhythmia, mechanical defects, drugs
  4. Hypoxic- adequate tissue perfusion but inadequate arterial oxygen content or cellular oxygen utilization
257
Q

What is the vascular supply to the skin?

A

Dermis:
Superficial/Subpapillary plexus
Middle/Cutaneous plexus

Hypodermis: Deep/subdermal/subcutaneous plexus

**Connections between plexuses allow for collateral flow to adjacent areas of the skin

258
Q

Tell me about the four dental blocks (locations)?

A

MAXILLA:
Infraorbital nerve block:
1-inch needle either intra- or extraorally about 1 cm cranial to the bony lip of the infraorbital foramen. Maxillary PM3 is a landmark

Maxillary nerve block:
1-inch needle ventral to the border of the zygomatic process and about 0.5 cm caudal to the lateral canthus of the eye. Direct the needle perpendicular to the skin and medially. Maxillary last molar is a landmark.

MANDIBLE:
Mental nerve block:
1-inch needle over the mental nerve, rostral to the middle mental foramen. Mandibular PM2 is a landmark.

Mandibular alveolar nerve block:
1 inch needle at the lower angle of the mandible about 1.5 cm rostral to the angular process. Direct and advance the needle 1.5 cm dorsally against the medial surface of the ramus of the mandible to the palpable lip of the mandibular foramen.

259
Q

Name the lung lobes:

A

Left:
- Left cranial (subdivided into cranial and caudal)
- Left caudal

Right:
- Cranial
- Middle
- Caudal
- Accessory

260
Q

Where is the thoracic duct in a dog?
A cat?

What intercostal space for access via thoracotomy?

A

In the thorax, the thoracic duct travels dorsolateral to the aorta on the RIGHT in dogs and LEFT in cats
10th ICS for thoracotomy

In dogs, at the level at the 5th or 6th thoracic vertebrae, the duct travels to the left.

Both species terminate at the left external jugular vein or jugulosubclavian angle

261
Q

Tell me all about colonic healing, specifically NSAIDS, anemia, and obstructions/tension?

A
  1. NSAIDs (carprofen) have been shown to cause sloughing of cells and erosion of the colonic mucosa, thus compromising the integrity and barrier function of the mucosa.
  2. Anemia (as low as 15%) does not seem to affect healing, and administration of blood transfusion may actually inhibit colonic wound healing.
  3. Tension should be minimal to avoid induced local ischemia - obstructions/stretch is not good.
    - PaO2 less than 40mmHg will prevent collagen formation
    - PaO2 less than 10mmHg will cause failure of angiogenesis and epithelial hyperplasia
  4. When fully healed, colon has a higher tensile strength (% of original strength) than skin
262
Q

What is the effect of clipping the fur >4hr prior to surgery?

A

Increased risk of surgical site infection. (possibly by re-contimination, consider covering skin if procedure is next day)

263
Q

What is the best test for determining hypercoagulability?

A

TEG (but if you don’t have it D-dimers)

264
Q

What is the role of the platelet in primary hemostasis?

A

As a source of preformed cytokines / later as a aggregator.

Platelets adhere to the exposed endothelial collagen, which activates them to release granules and start the cascade.
Thrombin is the most potent activator of platelets.

265
Q

Central venous pressure is the blood pressure within the intrathoracic cranial or caudal vena cava relative to atmospheric pressure. It reflects right atrial pressure. What factors affect CVP?

A

CVP is determined by interaction of cardiac function and venous return, these are influenced by:

Total blood volume
Vascular tone
Cardiac output
Right ventricular compliance
Intrathoracic pressure (using a ventilator)
Normal CVP: 0-8cmH2O or 0-5mmHg

266
Q

Colonic healing:
How long does mucosal healing take?

How long to 30% strength of submucosa? 75%?

A

Mucosa - 3 days

Submucosa is 30% at 48hr and 75% at 4 months (slower than SI)

267
Q

What is the Base deficit at pH 7.15 and HCO3- of 24 mEq/L?

At a pH of 7.47 with the same HCO3− of 24, what is the base deficit?

A

At a pH of 7.15 and HCO3− of 24 mEq/L, the base deficit will be 6. (metabolic acidosis)

At a pH of 7.47 with the same HCO3− of 24, the base deficit will be −1 (base excess, i.e., negative base deficit = metabolic alkalosis).

268
Q

Pancreatic blood supply?

A
  1. Celiac artery gives off the splenic and hepatic arteries:
    - The splenic artery supplies the left limb of the pancreas.
    - The hepatic artery -> cranial pancreaticoduodenal artery and supplies the cranial right limb and duodenum.
  2. Cranial mesenteric artery -> caudal pancreaticoduodenal artery supplies distal right limb and anastomoses to the cranial.
269
Q

Normal functions of the adrenal cortex /medulla?

A

Cortex: Steroids (GFR / sugar, salt, sex)
Medulla: Catecholamines

(normally don’t make a lot of sex hormones)

270
Q

Which antibiotics are negatively affected by acidic pH?

A

Erythromycin (macrolide) inhibited
Beta-lactams less activity (penicillins inactivated at (<6.0)
Aminoglycosides and fluoroquine less effective

271
Q

Because of the weak mechanical properties of immature bone, failure of the screw-bone interface with subsequent screw pull-out was a frequent complication associated with stiffer implants.

Elastic osteosynthesis was described to reduce complications. What are the components of this type of fixation? How does it work?

A

Applicable ONLY in skeletally immature animals - Best younger than 5-6 months

Relies on the use of long, thin, compliant plates that span entire length of bone between distal and proximal physes
Secured to bone with as few diverging screws as possible (typically 2 - four cortices proximal and distal)
No less than 3 open holes / 2.0/2.7 plate in med-large breeds

How it works:
Increases working length of plate (distance btwn the inner most screws)
Which increases the compliance of the construct [compliance = L^3 / (I x E) ]
Which allows plate deformation within its elastic limit
Indirectly spares bone-screw interfaces from excess shear stresses
Also contributes to preservation of periosteum and blood supply

272
Q

When using the gold end of the DCP 2.7 drill guide you will achieve ____mm of offset (for compression/loading) at each screw hold towards the fracture site?

A

1 mm

273
Q

The AO drill guides are color coded. What color is the eccentric (load) side and how far off center is it?

What color is the concentric (neutral) side and how far off center is it?

A

Eccentric = gold, 1mm off center for compression

Concentric = green (neutral) 0.1mm off center so small amount of compression

274
Q

The basic cellular unit of skeletal muscle is the myofiber. Describe it’s composition?

A

Made of myofibrils that are tandem arrays of contractile functional units called sarcomeres.
Sarcomeres are made of parallel arrays of overlapping actin and myosin filaments.
Myosin is thicker than actin.
- M line / I band contains myosin (myosin in middle)
- Actin binds to the Z band at the end of sarcomere
- A band all overlap (actin and myosin)

The sarcolemma is the cell membrane of the myofiber. If it is intact, they regenerate rapidly.

275
Q

What cells make collagen?

How is collagen made?

A

Fibroblasts make collagen. (and smooth muscle cells in GIT)
Made from amino acids in diet.

Pathway:
mRNA -> pre-pro-collagen
Pre-pro-collagen -> triple helix procollagen -> ECM
In ECM Procollagen ->tropocollagen

Fibrilogenesis assembles tropocollagen into macromolecular fibrillar complexes within the extracellular matrix = collagen

276
Q

What are the roles of COX-1 and COX-2?

A

COX1- housekeeping isoform that are typically found in GI mucosa, kidney, platelets, endothelial cells
- Predominant role in protection of the GI tract
- Decreases HCl secretion, increases mucosal bicarb and mucosal production, increase epithelial cell proliferation and mucosal blood flow

COX2- constitutively expressed in the kidney and brain
- major role is inducible in inflammation
- has cytoprotective effects in damaged or inflamed GI mucosa

277
Q

What are the mechanisms of metastasis for sarcoma?
For carcinomas/ round cell tumors?

A

Sarcomas metastasize via hematogenous spread
Carcinomas and round cell tumors metastasize via lymphatics

278
Q

What is the metastatic cascade?

A
  1. Cell detaches from primary tumor
  2. Migrates through surrounding tissues
  3. Intravasation into a microvessel
  4. Survival in circulation
  5. attachment to distant endothelial cell
  6. extravasation
  7. angiogenesis
  8. Proliferation
279
Q

In what way are matrix metalloproteinases (MMP, enzymes that aid in degradation of extracellular matrix) important in metastasis?

A

They help with invasion past the basement membrane by tumor cells.

280
Q

Tendons are dense bands of collagen rich fibers that connect muscle to bone or muscle to muscle.

What are the three forms of tendons?

A
  1. Aponeuroses - flattened structures that connect muscles to bones or other fascial elements (fascia of biceps femoris, rectus abdominis)
  2. Positional tendons - discrete and stiff structures that transfer muscular forces to bones (infraspinatus, DDF) CAN wrap around as they traverse joints.
  3. Energy storing tendons - have a greater elastic content to respond to weight bearing by elastic recoil (common calcanean tendon) - canNOT wrap around to connect to joints**
281
Q

What are ligaments?

Can a ligament have multiple attachments to the same bone?

What type of ligament is a focal thickening of the fibrous joint capsule?

A

Connective tissue bands that connect bone to bone.

Yes, the transverse humeral ligament is an example that has origin and insertion on same bone.
A capsular ligament.

282
Q

What is passivation?

A

Chromium, in the presence of air (oxygen), forms a thin film of chromium oxide which covers the surface of stainless steel implants.

The stainless steel passivation process chemically removes any free irons and forms a passive oxide “film” layer which further improves corrosion resistance.

283
Q

What are 2 types of viable non-unions and 3 types of non-viable non-unions?

Why do they occur?

A

Viable:
- Hypertrophic: motion
- Oligotrophic: loose implants –> poor vascularity –> lack of cellular activity

Non-Viable:
- Dystrophic: compromise of vasculature
- Necrotic: infected
- Atrophic: dead bone removed without replacement (defect: big gap)

284
Q

Reshaping of bone by osteoclasts is called what?

A

Resorptive modeling

Occurs on the periosteal surface as well as in the region previously occupied by epiphyseal cortex.

285
Q

What is primary neuronal injury?

What is secondary neuronal injury?

A

Primary: Mechanical damage (contusion, etc)

Secondary: A series of metabolic and biomechanical changes that cause neuronal and glial cell death. (increased intracellular Na, Cl, Ca -> cytotoxic edema; decreased astrocyte uptake of glutamate -> more extracellular glutamate -> increased excitation ->excitotixicity)

286
Q

Where is glove penetration most common?
Which type of glove is more resistant to perforation?
Post op perforation rate of gloves?
Double gloves?

A

The non-dominant hand
Latex are more resistant to perforation than vinyl gloves
Single: 12.7 - 31% perforations
Double: 3.8 - 13% perf for inner gloves (less holes, similar contamination rates)

287
Q

Name three ways of determining anesthetic depth?

What stage and plane of anesthesia should your surgical patient be at?

A

Clinical signs (pupil position, jaw tone, palpebral, PLR)
ETCO2
Brainwave activity - electroencephalogram - not good for dogs or cats

*For surgery goal is “Stage III, Plane 2” (light-medium, loss of palpebral), but Stage III plane 3 is acceptable (deep medium, loss of PLR)

288
Q

What does a reservoir bag on an anesthesia machine allow for?

How do you determine the appropriate size of reservoir bag for your patient?

A

Positive pressure ventilation (manual)

Reservoir bag size = 5-10x Tidal Volume (large enough to provide reasonable reservoir but not so big that it is difficult to see breathing

Big dogs should be minimum 6x TV

289
Q

What are the mechanical hemostatic agents?

A
  • Gelatin (Gelfoam)
  • Bovine collagen - Better than gelatin but more expensive
  • Cellulose (Surgicel)- acidic properties denature blood proteins stimulating hemostasis
    (However, acidity inactivates thrombin, which makes it the least effective hemostat)
  • Polysaccharide spheres (Hemablock)- hydrophilic and concentrates solid components of blood by dehydrating it / Volume can expand 500%
  • Bone wax/Ostene- blocks the surface and allows clot formation
290
Q

What are the active hemostatic agents?
Which cannot be used in a body cavity?

A
  • Thrombin - actively converting endogenous fibrinogen to fibrin and creating a clot
  • Alginates- seaweed derived protein that can be combined with calcium or sodium ion
    On contact, calcium ions are released 🡪 clotting cascade
    **Cannot be used intracavitary (only on wound surfaces) since they cause FB reaction
291
Q

How much compression do you get with a 2.7 DCP plate?

A

0.8mm

292
Q

Intracellular compartment is 2/3 of total body water and ___% of body weight?
Extracellular is 1/3 water and ___% weight?

A

Intracellular = 40% weight
Extracellular = 20% weight

293
Q

Of the 1/3 of total body water that is extracellular, how much is intravascular?

A

25% intravascular
75% interstitial

294
Q

the submucosa of the GIT is predominately what type of collagen?

A

Type 1 (68%)

295
Q

What types of collagen are in the skin? In the GIT?

A

1,3 in the Skin
1,3,5 collagen in GIT

296
Q

Unwounded skin contains what % of type 1 and Type 3 collagen?

A

Type 1: 80%
Type 3: 20%

297
Q

Describe type 1, 2 and 3 on the Gustillo-Anderson Classification scheme for open fractures?

A

Type 1: Wound < 1cm (sharp fragments make wound, then often retract below level of skin)
Type 2: Wound >1cm without extensive soft tissue damage, flaps or avulsions (often wound was caused by outside forces)
Type 3: Extensive soft tissue damage (avulsion, degloving, bone loss) fractures with neurovascular injury, gunshots, traumatic partial amputations

There are 3 subtypes of Type 3:
IIIa: Adequate soft tissue available
IIIb: extensive loss of soft tissue, periosteal stripping, massive contamination
IIIc: arterial injury that will require repair (often we amputate in vet med)

298
Q

For surgical approaches for different types of open fractures, what should you do?

A

Type I: Same as for closed fracture of the same type
Type II: Can sometimes treat same as closed - use your judgement
Type III: You may not be able to do internal fixation

** benefits of stability outweigh the potential harm of implants or need for future explant

299
Q

Name the phases of wound healing?

A

Inflammatory (early 24-48hr, late 48-72hr)
Proliferative (day 4-12)
- Contraction (soon after the granulation bed is established (dog day 4.5? cat later)
- Epithelization (on the edge of wounds it begins within hours)
Maturation (6wk collagen laid down / 12-18 months of organizing)

300
Q

What are the three potencies of stem cells?

A
  • Totipotent: can form ectoderm, endoderm, mesoderm AND extraembryonic tissues (trophectoderm)
    - From Zygote
  • Pluripotent: can form ectoderm, endoderm, and mesoderm
    - Embryonic stem cells and induced pluripotent stem cells
  • Multipotent: can only form the germ layer from which they originated from
    - Adult stem cells
301
Q

What are consequences of EHBO that may affect a surgery patient (6)?

A

hypotension
decreased myocardial contractility
acute renal failure
coagulopathies
GI hemorrhage
delayed wound healing

302
Q

How do local anesthetics work?

A

Local anesthetics block the voltage-gated sodium channels of C- and A-type nociceptive fibers. Nerve cell depolarization is prevented -> blocking the conduction/transmission of nerve impulses to higher brain centers.

They all inhibit at the dorsal horn.

303
Q

What is the infection rate for clean surgery?

A

2.5-4.8%
(other sources 2-5%)

304
Q

Do all dogs have pulmonary lymph nodes that drain lymph from lungs and then to tracheobronchial nodes?

A

No, not all dogs have them.
They are in the visceral group of resp. nodes
Parietal nodes (sternal, etc) drain that side of things.

305
Q

What is the most prevalent GAG?
What is an unsulfated, building-block GAG?

A

Chondroitin sulfate is the most prevalent GAG
Hyaluronic acid is an unsulfated “backbone” for making other GAGs

306
Q

Describe the (adult) aortic arch?

A

Arises cranially toward left as aortic arch and ascending aorta
Curves dorsocaudally to form descending aorta
First branch is brachiocephalic trunk
- gives off common carotid and right subclavian aa.
Second branch is left subclavian a.

307
Q

TNF-a stimulates COX-2 expression in which tissues?

A

Synovium, endothelium, chondrocytes, osteoblasts, monocytes, macrophages

308
Q

What is the difference between Nuclei and Ganglia?
What is the most important nucleus?

A

Nuclei are collections of neuronal bodies in the CNS
Ganglia are OUTSIDE CNS

Caudate nucleus.

309
Q

The cerebrum consists of cerebral hemispheres and basal nuclei.
What are the 6 cortical areas (by function)?

A

Olfactory
Frontal
Parietal
Temporal
Occipital
Limbic system

310
Q

Which is superficial, grey or white matter?

A

Grey matter (basal nuclei) is superficial
White matter (tracts and fibers) is deep

311
Q

How long is a cycle in a gravity-displacement steam sterilizer?

A

**121C for 30 min and 15-30 drying
or
132C for 15 min and 15-30 drying

312
Q

When should you use dry heat sterilization?

A

For certain sharp instruments, powders, and glassware that may be damaged by steam

313
Q

How long is a flash sterilization cycle?

A

135C for 3 minutes, with 1 minute drying

314
Q

How long (in weeks) are plastic/paper pouches and double layer linen considered sterile after steam sterilization?

A

96 weeks

315
Q

In the cardiac cycle, the area under the pressure/volume curve (area inside the yellow/red loop) represents what?

A

The net external WORK of the ventricle

316
Q

What (4) causes of hypoxia respond to oxygen?

What has a poor response?

What has no response at all?

A

Respond: hypoventilation, low FiO2, Diffusion impairment, high V/Q (PTE)

Poor response: Low V/Q (pneumonia, atelectasis, alveolar collapse, edema)

No response: Right to left shunting

317
Q

Describe the flow of fluid through the pleural space:

A

parietal -> out into pleural space -> absorbed by visceral

318
Q

What is the WHO staging for skin tumors?

A

TNM staging:
Stage 1: T1N0M0 (tumor < 3cm diameter)
Stage 2: T2N0M0 (Tumor 3-5 cm)
Stage 3: T3N0M0 (Tumor >5cm)
Stage 4: TxN1M0 (met to ipsilateral node, independent of T size)
Stage 5: TxNxM1 (distant mets)

319
Q

What is the primary cell type in inflammation at:
24-48hr?
48-96hr?

A

24-48: Neutrophils
48-96: Macrophages

Lymphocytes arrive at 3-5 days

320
Q

What is the difference between paratenon and sheathed tendons?

A

Paratenon = has a vascular supply that can help heal with vascular buds (gastroc, triceps)
Sheathed = avascular, more difficult to heal (DDF)

321
Q

Phenylbutazone MOA?

Side effects?

A

Non-selective COX
Phenylbutazone binds to and inactivates prostaglandin H synthase and prostacyclin synthase through peroxide (H2O2) mediated deactivation.

Can cause blood dyscrasias, renal failure and biliary stasis
DON’T use in cats

322
Q

What is the coronary ligament of the liver?

A

The coronary ligament attaches the liver to the diaphragm and is a continuation of the hepatic peritoneal covering, which is present over the entire surface of the organ except for the region of the porta hepatis.

Emanating from the coronary ligament are two right-sided triangular ligaments.

In most cases, a single left-sided triangular ligament attaches to the left lobe of the liver.

The hepatorenal ligament attaches the caudate lobe of the liver to the right kidney.

323
Q

For local anesthetics - what are differential blocks? (what is the order of effect of LA)?

A
  1. Vasodilation (erythema/increased temp) first
  2. Loss of sensation of temperature
    - C fibers, 0.3-1 μm diameter, unmyelinated
  3. Loss of sensation to sharp pain
    - A-delta fibers, 1-4 μm diameter, myelinated
  4. Loss of sensation to light touch
    - A-beta fibers, 5-12 μm diameter, myelinated
  5. Loss of motor activity
    - A-alpha fibers, 12-20 μm diameter, myelinated

Erlanger and Gasser classified nerve fibers into three major groups (ABC)- the larger the nerve fiber, the more resistant it will be to local anesthetic blockade.

324
Q

What is the benzodiazepine of choice for hepatic dysfunction or otherwise delayed metabolism?

A

Midazolam - it’s metabolite has minimal residual activity. (Diazepam’s metabolites are active).

325
Q

In metastasis, what is the best biologic barrier to neoplastic cells?

A

Fascia, bone, or cartilage

326
Q

What is Wolff’s law?

A

Bone in a healthy animal will adapt to the loads under which it is placed (why bone remodels with loading/use).

327
Q

What is the weakest part of the physis/site of most SH fractures?

A

Hypertrophic zone

328
Q

Is the carpal joint capsule contiguous with the interosseous ligament?

A

Yes.

The Fibrosa of the joint capsule is continuous with the interosseous membrane and cranially forms the radioulnar ligament.

329
Q

What is the best choice for a primary layer (dressing) on a wound in the inflammatory/early repair stage?

A

A hyperosmotic agent:
-Honey
-Sugar
-Hypertonic saline

Inflammatory/repair stage: hydrophilic/moisture retentive
Maturation stage: non-adherent semi-occlusive like a telfa

Adherent (wet to dry or dry to dry) NOT RECOMMENDED ANYMORE

330
Q

The esophagus is innervated by branches of the vagus. Describe it’s blood supply?

A

Segmental:
Cervical= cranial and caudal thyroid aa. (common carotid)
Cranial 2/3 = bronchoesophageal a. (aorta)
Caudal 1/3 thoracic = esoph. branches of aorta or dorsal intercostals
Terminal portion= Left gastric a.

331
Q

Describe “uncomplicated” starvation:

A

In response to prolonged starvation, the body lowers its metabolic rate to decrease nutrient needs.
- Initially glycogen is used for glucose, to conserve fatty acids and protein.
- Once glycogen is depleted -> use fatty acids as primary source of energy.
- Hepatic gluconeogenesis using proteins supports organs that need glucose.

Death takes weeks, and is due to respiratory or cardiac failure.

332
Q

What two things are secreted by the duodenal mucosa?

A

Secretin -> stimulates secretion of large amounts of HCO3 to neutralize gastric acid

Cholecystokinin -> stimulates secretion of digestive enzymes and bile

333
Q

Which tongue papillae are NOT gustatory (tasting)?

A

Filiform and Conical papillae have no taste buds.

They are innervated by the hypoglossal nerve (XII).
(Taste is CN VII, IX, X)

334
Q

GI healing is affected by local issues such as hypoperfusion, tension/poor apposition, and infection, but it is also affected by systemic issues - what are these (8 total)?

A

Hypovolemia (duh)
Zinc or iron deficiency
Blood transfusions
Medications (cisplatin)
Immunodeficiencies
Poorly controlled diabetes
Icterus

335
Q

How do defibrillators work?
What rhythm do you use them in?

A

They depolarize the WHOLE heart. If the heart can’t create it’s own electrical pulse, then a defib shock will not help return to rhythm.

Vfib is the shockable rhythm

336
Q

What are the two types of BPH? What age dogs do you see each type in?

A

Glandular hyperplasia in younger dogs (<4-5 years)
- symmetric, secretory cell driven

Complex hyperplasia in older dogs
- asymmetric, stromal elements (some glandular)

337
Q

How long is the distal feline male urethra?

A

8.5 - 10.5 cm with a distinct preprostatic urethra (2mm dia).

338
Q

What is the most common bacteria isolated in canine otitis externa?

A

Staph. intermedius or pseudintermedius

Others: P. aeruginosa, Proteus, E. coli etc.

339
Q

How does cephalexin respond in an abscess?

A

All that acute inflammation may increase penetration by beta-lactam antibiotics.
It’s high binding to plasma protein will also help bind it to inflammatory proteins to get there.

340
Q

Oral absorption of fluoroquinolones can be affected by what?

A

Sucralfate

341
Q

Which two opioids are known for histamine release causing hypotension?

A

Meperidine and Morphine

The other major CV effect is bradycardia (centrally mediated/ vagus)

*a practice q said buprenorphine given IV?

342
Q

For one lung ventilation, which tube type is best?

A

A double lumen tube (DLT)
Next best is a bronchial blocker (long catheter with balloon to occlude)
LEAST desirable is just a long standard ET tube

343
Q

What is the benefit/use of helium mixed in with your oxygen in anesthesia?

A
  • Can reduce effort of respiration as it has less resistance to flow than air or O2. (heliox increases tendency to laminar flow)
  • Can prevent fire caused by ignition of gas during laser surgery (use at a 70:30 ratio)
344
Q

Methadone MOA?
What about cats?

A

2x as potent as morphine
Also NMDA receptor antagonist -> fewer excitatory responses in cats

345
Q

Does buprenorphine have a ceiling effect?

A

yes. higher doses just last longer
40x morphine potency

346
Q

Pain is transmitted to higher brain centers via large tracts. What are their names?

A

Spinothalamic tract - cord to thalamus
Spinoreticular - cord to reticular formation
Spinomesencephalic - to midbrain
Thalamus -> to midbrain

347
Q

What are the three phases on an end tidal capnography wave?

A

Phase 1: Baseline
Phase 2: Rise
Phase 3: Plateau

348
Q

What are Potts-Smith scissors used for?

A

Cardiovascular stuff (long, thin shaft looks like a bird face)

349
Q

How much contact time do you need with chlorhexidine hand scrub?

A

3 minutes (no different than 5 min)
but you should really just use alcohol
Under the nails is most common residual site.

350
Q

Nd:YAG (1064nm) lasers are used for what?

How about Ho:YAG (2100nm)

Er:YAG?

A

Nd:YAG can be used for endoscopic procedures or for OVE - can coagulate vessels and has a deeper tissue effect

Ho:YAG is good for arthroscopy (joints!) and lithotripsy - it is highly absorbed by water DON’T use a CO2 in a joint

Er:YAG Bone

351
Q

Harmonic scalpels what is different/good?

A

Can cut and coag at lower temps (50-100C)
Vibration-induced heat is cause of coag (no electric current)
Ultrasonic coaptive coagulation
Can only seal 3mm

352
Q

What is different between a GIA and an EEA device?

A

GIA has four staggered rows of staples - 2 on each side of blade. 3.5 height -> closed 1.5

EEA is circular, double staggered (4 rows all around) and a stoma is created inside the rows.
The EEA anastomosis is INVERTED. It should not be used on tissue < 1mm thick or >2.5

353
Q

What do you clamp in a Pringle maneuver?

A

Hepatic artery and portal vein (and CBD)
Can be occluded 10-15 min

354
Q

Describe Base excess / base deficit:

A

Base excess/deficit equals the amount of acid or base that is required to restore the total buffer base of ECF to a pH of 7.40

A normal BE is -4 to +4
Positive BE = metabolic alkalosis
Negative BE(base deficit) = nonrespiratory = metabolic acidosis

355
Q

How do you determine if a blood gas is respiratory? If it’s compensated?

A

Resp Acidosis = hypoventilation -> hypercapnia (PaCO2 high)
- compensation is elevation of HCO3
Resp alkalosis = hyperventilation -> hypocapnia (PaCO2 low)
- compensation is decreased bicarb
Metabolic acidosis = decreased bicarb
- compensation is hyperventilation (decreased PaCO2)
Metabolic alkalosis = increased bicarb
- compensation is hypoventilation (increased PaCO2)

356
Q

Where do the multipotent, mesenchymal stem cells (MSCs) that hang around bone marrow come from?

A

Embryonic mesoderm

They’re anti-inflammatory and immunosuppressive

357
Q

True or false? When fully healed, the colon has a greater % of original strength than skin?

A

True!
See chart: Bladder > Stomach > Colon > Skin

358
Q

How strong is fascia at 6 months post wounding?

A

60-80%

At 2wk 20% / 1 month 50%

359
Q

What cell makes TGF-B?

A

Fibroblasts (and others) it turns fibroblasts into myofibroblasts

360
Q

What is the Kussmaul sign?

A

Paradoxical Jugular distention on inspiration.
In cardiac tamponade the negative pressure of inspiration can’t distend the atrium due to external pressure and instead pulls the ventricular septum to the lower pressure side (right) pushing volume back into the jugulars.

361
Q

Describe the blood supply to the stomach:

A

Celiac a. -> splenic artery -> left gastroepiploic artery -> greater curvature and anastomoses with the right gastroepiploic artery.
Celiac a. -> hepatic artery -> right gastric artery -> pylorus and pyloric antrum and anastomoses with the left gastric artery -> lesser curvature
Hepatic artery continues as the gastroduodenal artery -> the right gastroepiploic artery-> greater curvature of the stomach
Celiac a. -> left gastric artery -> fundus and caudal esophagus before joining the right gastric artery -> lesser curvature

** The short gastric arteries originate from splenic branches of the splenic artery and anastomose with the gastric branches of the left gastric artery to supply the fundic area of the stomach

362
Q

What % of weightbearing in the elbow joint is done by the radius?

A

51% of the forelimb weight-bearing force is carried by the proximal radial articular surface at the level of the elbow; the remaining force is thus born by the ulna.

363
Q

Does the proximal ulnar physis contribute to the length of the ulna?

A

NO
The proximal ulna possesses a physis that is responsible for olecranon elongation only.

364
Q

Can you remove and replace a self tapping screw?
How much length (mm) should you add to your measured screw length?

A

Yes, you can remove and reorient/replace a self tapping
Add 2mm to ensure there is good purchase in the far cortex

365
Q

What is hyperalgesia?
What is allodynia?

A

Hyperalgesia is an increased sensitivity to feeling pain and an extreme response to pain.

Allodynia is pain due to a stimulus that does not normally provoke pain (light touch).

366
Q

What are the three phases of cartilage damage in OA?

A
  1. Extracellular matrix degrades, water content increased, size of aggregan molecules decreased and structure of collagen network is damaged leading to reduced stiffness
  2. Chondrocytes try to compensate through enhanced proliferation and metabolic activity. Cell clusters appear surrounded by newly synthesized matrix molecules.
  3. Chondrocytes are no longer able to keep up, resulting in complete loss of cartilage tissue

Phase 1/2 - thickness, swelling as proliferate -> phase 3 loses the battle and thins away

367
Q

If the same amount of deformation occurred at a fracture site in a great dane tibia (300mm) and a miniature poodle (100mm), which one would experience greater strain?

A

The poodle. Strain is deformation / total length….
so x/100 is definitely greater than x/300

368
Q

Where do the ovarian arteries arise from the aorta?

A

Caudal to the renal arteries and cranial to the deep circumflex iliac arteries.

  • Right ovarian vein drains into the caudal vena cava
  • Left ovarian vein drains into the renal vein
369
Q

What are the 4 types of idiopathic IMPA?

A
  • Type I: Idiopathic (50%)
  • Type II: reactive IMPA with infection remote from joint (25%)
  • Type III: IMPA associated with GI disease (15%)
  • Type IV: IMPA associated with neoplasia (paraneoplastic)

“I Remember Grades of Polyarthritis”

370
Q

What is the infection rate for cystotomies when there is no concurrent UTI?

A

5% (same as complication rate)

Uroabdomen is 1.5%

371
Q

What is the relative strength of the bladder (% of normal) at 21 days post cystotomy?

A

100%

372
Q

What vein causes severe hemorrhage in TECA-BO?

A

Retroglenoid vein. It sits rostral to the osseous ear canal/meatus.

373
Q

What is in the tube for an ACT (coag) test?

A

An activator for Factor 12
(kaolin, glass beads etc.)

374
Q

What nerves supply sensory and motor function to the external ear canal?

A

Sensory: Vagus
Motor: Facial**

375
Q

Do tourniquets prevent edema?

A

NO

Tourniquet injury can cause significant postop edema and swelling and you should evaluate the limb / change the bandage at 24 hours to avoid further bandage complications.

376
Q

What are the main classes of stem cells (3 natural, one created)?

A

Embryonic (ESCs)
Adult (ASCs)
Fetal/Perinatal (PSCs)

Artificial = induced pluripotent (IPSCs)

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